Cirrhotic Cardiomyopathy: Another Case of a Successful Approach to Treatment of Hepatorenal Syndrome

Abstract

Hepatorenal syndrome (HRS) is defined as a failure of renal function, potentially reversible, in patients with liver cirrhosis and ascites. Recently, a component of cardiomyopathy associated with HRS was described, but the use of positive inotropic medicine as part of the treatment of the acute phase has not been extensively evaluated. We report a second case in our hospital of a patient with HRS type I without previous heart disease, with secondary hemodynamic decompensation due to liver disease, in which the abnormalities in systolic function by speckle-tracking echocardiography were observed and could be reversed by the use of inotropes. After partial response to current therapies, the patient presented a clinical and laboratorial response with improvement of renal function after infusion of dobutamine. Clinical studies are needed for the therapy approach to HRS taking into account myocardial dysfunction as a major contributing factor for renal dysfunction.

Cirrhotic cardiomyopathy: we already know. What comes next?

“…Liver transplantation and TIPS are special clinical settings that may deflagrate heart failure in these patients. As patients survive longer after these procedures, clinicians would be faced with worsening cardiac parameters [21].…”

“…This progression to HRS is understood since existence of CCM is a trigger and perpetuating factor of HRS, so if CCM is approached early in this context, HRS can have a better prognosis [21].…”

“…The goal is to apply this theoretical knowledge anticipating this complication in end-stage liver disease patients [6].…”

“…Ionic channels dysfunctions thereby causes myocardial cells action potential prolongation, resulting in longer ventricular systole and QT [21][22][23]. Longer contraction time implies impaired relaxation, causing diastolic dysfunction [24,25].…”

“…However, there's still a gap of knowledge regarding management of this condition [6]. The presence of myocardial dysfunction in cirrhosis increases the risk of hepatorrenal syndrome (HRS) and adverse cardiac events and it is related to higher mortality [3].…”